Healthcare Sharing Plans: Is there a better option?

Wouldn’t you be interested if you could reduce your monthly health care costs while still getting the care you need? Of course you will. This is the simple proposition at the heart of the appeal of health care sharing plans, also known as health care sharing ministries.

Shay Welch

They evolved from decades-old health care plans and have exploded in popularity since 2010. The idea is that a group of people, often with a common religious belief system, pool funds to pay for each other’s medical needs. However, as many Americans are discovering, these largely unregulated plans can leave their members with surprising bills for some shocking reasons.

Clients should be aware that their employees may be tempted to join health care sharing units. Brokers should ensure that their clients are prepared to educate employees about the content of these programs and the dangers they may pose.

from the very beginning

The roots of the health care sharing sector date back more than a century, primarily to Amish and Mennonite communities, where individuals and families pooled funds to reduce personal debt burdens. By the end of the last century, this model was adopted by more faith communities across the country, primarily Christianity.

With the passage of the Affordable Care Act of 2010 and its separate mandates, health care sharing agencies received certain exemptions from the law’s requirements. This allows ministries to offer cheaper options by eliminating more expensive coverage.

When the bill passed, an estimated 100,000 people were enrolled in the health care sharing sector; by 2018, that number reached 1 million. According to a recent national survey conducted by the Colorado Department of Insurance, more than 1.7 million people are currently enrolled in these plans.

Any questions?

These ministries are subject to few rules. They must be 501(c)(3) organizations based on common beliefs and have been operating in some form since December 31, 1999. There are additional rules regarding non-discrimination, auditing and ensuring that members are not eliminated for development. Physical conditions. Beyond that, they are largely free to determine coverage, set eligibility criteria, decide how much to pay, and even the schedule for reimbursement.

What does this mean in practice? By operating as a nonprofit outside of ACA oversight, health care sharing ministries claim exemptions from federal and state insurance laws and are therefore not guaranteed, said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reform. The organization is able to maintain funds sufficient to pay the claims, but there is certainly no guarantee they will, even if the funds are there. There are no solvency requirements and no timely payments to members – no payments at all. Although marketing often suggests otherwise, whether a claim will be paid is really just a matter of belief.

The plans won’t cover pre-existing conditions, KFF Health News Colorado senior reporter Markian Hawryluk reports. There are ethics clauses here, for example, they won’t cover things like abortion, birth control, often mental health care. They do not cover chronic medications. They will not cover children born out of wedlock. Or if you were injured from drinking or taking drugs, illegal drugs, they won’t cover those things.

Additionally, many of these plans require their members to try to have their care covered by the government or the hospital as a charity case before submitting a reimbursement bill to the plan, according to Hawryluk.

Adding insult to injury, recent investigations have uncovered alleged instances of massive financial malfeasance by plan administrators, who are accused of embezzling millions of dollars from member care in some of the largest health care sharing units in the country.

better choice

Members should ask themselves whether a reduced-price version of health insurance is worth the cost, given the risk of claims being ignored or denied, the lack of solvency oversight and the additional administrative burden it places on them, a decision brokers need to make for some employers. Provide members with better choices when it comes to employee benefits.

Shea Welch is the company’s vice president of product, managed care and marketing strategy Health Benefits of Luminare. Contact him: [email protected].

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